与讲师见面

Antoine Flahault

Professor of Public Health and Director of the Institute of Global Health (Faculty of Medicine, University of Geneva) and co-Director of Centre Virchow-Villermé (Université Paris Descartes)University of Geneva and Université Paris Descartes – Sorbonne Paris Cité

Rafael Ruiz De Castañeda

Institute of Global Health - Faculty of MedicineUniversity of Geneva

Defeating Ebola Together "Closing Remarks"

>> Well, we've reached the end of our MOOC: five weeks spent with students, professors, and experts.

Without trying to recap the entire course, what do you feel have been its key messages?

Let's try, you and I, to summarize the information that seems most important to us. Why don't you get us started?

>> For one thing, we learned that something as simple as hand hygiene -- washing your hands properly, understanding the importance of good hygiene, both generally

and for hand hygiene in particular -- are absolutely crucial in Africa.

>> It could arguably have prevented the Ebola epidemic altogether.

Funeral rites are also an important factor -- something epidemiologists would likely not have discovered alone.

>> Absolutely: funeral rites in Africa are a highly complex phenomenon, and in terms of this epidemic, they have been central to the disease's propagation.

Addressing such a complex issue, from a culture and tradition standpoint, is quite difficult.

It requires the participation not only of doctors and epidemiologists, but of anthropologists as well, as we learned in this MOOC.

>> Let's move on, now, to the environmental side of things: the role of fruit bats in spreading Ebola is also quite complex.

>> Yes, clearly -- accounting for animal dynamics adds another layer of complexity. Ebola is a complicated process in terms of infection and epidemiology.

You have populations of wild animals; highly mobile human populations; a region full of movement and activity.

So gaining an understanding of the epidemic and the dynamics of infection requires a systemic, environmental approach.

>> Despite this complexity, there is hope as relates to treatments and vaccines.

Investigational research efforts were set up very rapidly,

with innovative and unprecedented funding models.

>> Yes, we learned that Ebola patients can recover. Some treatments, even though they are still in the experimental phases, are able to cure Ebola.

At the same time, there is an ethical responsibility to accelerate our research procedures

in order to obtain reliable scientific results much faster, despite the challenges associated with the disease.

>> Yet, although Ebola is a complex disease, its symptoms actually lack specificity.

>> Absolutely. In fact, many of its symptoms match those of other tropical diseases,

most notably malaria: high fever and non-specific symptoms that make it that much harder to diagnose.

That's clearly a major challenge.

>> We learned from historians that Ebola has similarities with epidemics of the past, yet is uniquely modern as well. Modern tools such as Big Data

and mathematical modeling have demonstrated their usefulness, despite some predictions lacking in rigor or,

at the very least, unlikely to come true -- fortunately. Yet these tools remain extremely promising.

>> I agree. The field of Big Data is clearly exploding right now. It offers the ability to leverage highly complex and rich data.

The use of mobile phone data in Africa will allow us -- and has already allowed us -- to understand the mobility and dynamics of large groups of people.

This is very promising in terms of better grasping and interpreting how these epidemics develop and spread.

>> During this MOOC, we also heard from politicians -- which is somewhat unusual --

who shared their opinions and demonstrated their commitment. Political leaders from Switzerland and France clearly played a major part in organizing humanitarian aid.

Yet you get the sense that the orchestra needs a conductor, that an organization like the World Health Organization needs to

assert its leadership when dealing with situations that go beyond the local scope.

>> Absolutely, and I feel the course did a good job of highlighting the importance of effective public health governance.

Addressing these complex problems on a worldwide scale requires effective communication and exchange -- on an interdisciplinary, multi-sector basis -- among all the key actors.

>> You may remember a certain philosopher whose famous phrase was "Time for Outrage!" Some things make you very cautious, others are shocking.

Violence against medical workers is shocking; the fact that a vaccine could perhaps already have been developed is shocking

-- after all, we've known about Ebola for 38 years. We knew it was dangerous, highly contagious, and we knew it might produce another epidemic -- yet nothing was done.

In fact, there may be other viruses out there for which no vaccine is being developed, on which the international community is not focusing.

>> Yes, I agree. One thing that's absolutely crucial, and which this MOOC has insisted upon over and over,

is the importance of communication, particularly in Africa,

where people and communities need to be involved and educated, at every level, from the very beginning.

There are many challenges when doctors arrive to provide medical care in places with very complex traditions.

It is a must that they be able to communicate very clearly but also that they take the time to understand people's outlooks and beliefs.

>> Now, in Africa, it's clear that the weakness of healthcare systems played a huge role.

Yet Nigeria, for instance, provided a clear counter-example.

>> Yes, experts from Nigeria told us how they were able to achieve great success in terms of infection control,